How to stop docs, nurses from coming to work sick

The vast majority of physicians and nurses report to work when they are sick in spite of the risk it poses to patients and other personnel. But it will take an institution-wide approach to stop the practice and encourage clinicians to stay home when they are ill, according to a study published in JAMA Pediatrics.

More than half of the 900 attending physicians and advanced practice clinicians (APCs) at a large children's hospital in Philadelphia, Pennsylvania told researchers they thought working while sick created an unnecessary risk for patients. Yet, more than 8 in 10  said they had worked while sick--known as "presenteeism"--at least once in the past year, with 9.3 percent reporting they had done it at least five times.

Physicians said they worked while sick because they didn't want to disappoint their patients. Other clinicians said they reported to work when ill because they felt that their absence would result in poor patient care as their coworkers struggle to keep up with the increased workload.

"Institutional culture also contributed to presenteeism," wrote the authors, led by Audrey L. Tanksley, M.D., "including not wanting to disappoint colleagues, fear of ostracism from colleagues, unsupportive leadership, and coming to work while ill because their colleagues do the same."

So how can hospitals fix this issue? One possible approach would be organization-wide triage policies for ill healthcare workers, researchers suggest. For example, University of Chicago health system workers who exhibited upper respiratory symptoms or fever were tested for influenza virus during a recent flu season. If the tests came back positive, the workers were ordered to stay home for at least seven days, which cut the rates of flu cases transmitted from clinicians to patients, according to the study. The authors further suggest applying a "fitness for duty" metric similar to the benchmark used by the airline industry for its pilots.

The report went on to strongly recommend that hospitals and healthcare institutions have backup staffing measures in place for both physicians and APCs so that sick workers can stay home without fear of compromising patient care. This relieves clinicians of the burden of arranging their own coverage when ill.

Furthermore, the study recommended "self-assessment strategies or checklists such as 'I'M SAFE' from airline pilots may promote routine self-assessment and peer assessment of fitness for duty."

To learn more:
- here's the study abstract